INTEGRATING GEROPSYCHOLOGY SERVICES INTO MEDICAL SETTINGS

Abstract Integrating behavioral health into medical settings, such as primary care clinics, has been shown to have a positive impact on the well-being and health of patients. Increased access to mental health services as well as increased identification of psychological issues is an important goal for all patients but may be of particular importance for geriatric patients who often have multiple chronic conditions along with an increased risk of neurocognitive disorders. This paper is intended to describe the process of starting an integrated geriatric behavioral health service line into geriatric and internal medicine clinics at a large urban hospital that serves a primarily underserved population of patients. MetroHealth Medical Centers serves over 300,000 patients, 75% of whom are uninsured or covered exclusively by Medicare and/or Medicaid. The system has one centralized geriatric medicine clinic as well as geriatric providers throughout the system. In 2021, a geropsychologist was brought on board to create a geriatric mental health service for the system. Three different models of integrated care are being used – within-clinic collaborative care, co-location of services, and referrals – and will be described further. There have been over 1200 referrals to the service since its inception, many of whom are receiving mental health care for the first time. This presentation will highlight the types of patients being referred and the efforts put forth to reach as many patients as possible. Finally, the development of Geropsychology-specific training opportunities for psychology and medical residents and fellows will be described.

Positive and negative affect may impact health in older adults and their family caregivers.However, how members of a caregiving dyad may influence each other's health outcomes is not well understood.The purpose of this analysis was to simultaneously examine whether both dyad members' positive and negative affect were associated with their own and each other's mental health (depression and anxiety) and perceived general health.Dyadic data were obtained from the National Health and Aging Trends Study (NHATS) (2021) linked to the National Study of Caregiving (NSOC) IV (2021).The sample consisted of 1,209 pairs of adults aged 71 and older and their respective primary caregivers, defined as the family member or friend who provided the greatest number of hours of care in the preceding month.Actorpartner interdependence models were used to examine associations between positive and negative affect, mental health, and perceived general health, controlled for dyad members' own gender, age, and race/ethnicity.Results indicated that positive and negative affect significantly predicted caregivers' and older adults' own mental health and perceived general health.Furthermore, older adults' negative affect significantly predicted caregivers' expressing little interest or pleasure in doing things (b = 0.033 (0.016), p = .046).Our results suggest that an individual's mood influences their mental health and perceived general health even when considering partner effects.Caregivers' interest or pleasure is particularly impacted by older adults' negative affect.Dyadic supportive strategies to improve mood could be beneficial for both older adults and their family caregivers.Tactile hallucinations can be highly distressing and lead to psychiatric morbidities and functional impairments.There are no established treatments for tactile hallucinations that occur outside of primary psychotic disorders, and available pharmacologic and nonpharmacologic therapies may have limited effectiveness.We present a case of a 75-year-old female with treatment-refractory tactile hallucinations successfully treated with electroconvulsive therapy (ECT).She endorsed 13 months of distressing tactile hallucinations described as slimly substances on her skin.Symptoms started insidiously, became more severe with time and refractory to multiple antipsychotic medications.She became so severely distressed from the tactile hallucinations that she developed a major depressive episode and became suicidal.Relevant medical history included one prior depressive episode, occipital lobe stroke, restless legs syndrome, and obstructive sleep apnea.She was hospitalized in an inpatient psychogeriatric unit and treated with ECT for 12 sessions over 3.5 weeks.Hallucinations responded well to ECT.Patient experienced some mild memory impairment from treatment.Treatment was optimized with duloxetine titration, addition of mirtazapine and repletion of B6 vitamin.Following the acute course of ECT, she reported an 80 % improvement in tactile hallucinations.Depressive symptoms improved, and suicidal thoughts resolved.She was able to discharge from the hospital and continued with maintenance ECT.Our case illustrates the potential therapeutic role of brain stimulation in the treatment of refractory cases of tactile hallucinations.Further studies are needed to determine effective treatment strategies for treatment-refractory tactile hallucinations to prevent progression to severe psychiatric disturbances and improve quality of life.

GENDERED TRAJECTORIES OF DEPRESSIVE SYMPTOMS IN OLDER KOREAN PARENTS BEREAVED OF AN ADULT CHILD
Sujeong Park, and Jinho Kim, Korea University, Seoul, Republic of Korea Despite the existing body of research on the impact of child bereavement, little is known about whether time to the death of an adult child is associated with changes in depressive symptoms among older Korean parents.This study examines (a) trajectories of depressive symptoms before and after the loss of an adult child and (b) whether these trajectories differ across parent-child pairs (father-son, father-daughter, mother-son, and mother-daughter).Using eight waves of the Korean Longitudinal Study of Ageing (KLoSA), the study employs fixed effects models to mitigate potential bias due to unobserved individual-level heterogeneity.The result of this study revealed that depressive symptoms increased within the first year following the loss of an adult child among bereaved parents.Considering the gender of both the parent and the deceased child, differences in psychological adjustment to bereavement were observed in different dyads.Depressive symptoms surged within the first year and persisted even beyond the fourth year of loss among daughter-bereaved fathers, while only an immediate rise in depressive symptoms within the first year of loss occurred for other pairs.Given prevailing gender role socialization in the Korean context, men's conformity to masculinity norms and the traditional expectation for daughters to provide emotional support may contribute to the long-term increase in depressive symptoms for fathers who have lost a daughter.Thus, in societies where Confucian gender culture is ingrained as a social norm, policies for the psychological support of older parents who have lost adult children must consider the different trajectories of parent-child relationships.

INTEGRATING GEROPSYCHOLOGY SERVICES INTO MEDICAL SETTINGS Ann Pearman, MetroHealth Medical System, Cleveland, Ohio, United States
Integrating behavioral health into medical settings, such as primary care clinics, has been shown to have a positive impact on the well-being and health of patients.Increased access to mental health services as well as increased identification of psychological issues is an important goal for all patients but may be of particular importance for geriatric patients who often have multiple chronic conditions along with an increased risk of neurocognitive disorders.This paper is intended to describe the process of starting an integrated geriatric behavioral health service line into geriatric and internal medicine clinics at a large urban hospital that serves a primarily underserved population of patients.MetroHealth Medical Centers serves over 300,000 patients, 75% of whom are uninsured or covered exclusively by Medicare and/or Medicaid.The system has one centralized geriatric medicine clinic as well as geriatric providers throughout the system.In 2021, a geropsychologist was brought on board to create a geriatric mental health service for the system.Three different models of integrated care are being used -within-clinic collaborative care, co-location of services, and referrals -and will be described further.There have been over 1200 referrals to the service since its inception, many of whom are receiving mental health care for the first time.This presentation will highlight the types of patients being referred and the efforts put forth to reach as many patients as possible.Finally, the development of Geropsychology-specific training opportunities for psychology and medical residents and fellows will be described.

INTEROCEPTION ACROSS DOMAINS: ASSESSING THE ROLE OF AGE Pietra Bruni, VA Connecticut / Yale School of Medicine, New Haven, Connecticut, United States
Interoception plays a prominent role in homeostasis, providing information about the internal state and condition of the human body.It is most typically measured using heartbeat tasks, though there are mounting criticisms against focusing exclusively on signals that originate from the cardiac domain.While prior research has shown that variability in interoceptive ability exists when examined in relationship to numerous health, biological, and psychiatric factors, the role age holds remains largely unexamined.The primary goal of this study was to assess interoception in two distinct domains, cardiac and respiratory, across a community sample (n = 40) of twenty younger (mean age = 24.9years) and twenty older (mean age = 69.3years) adults.Two laboratory tasks measured interoception: a Heartbeat Tracking Task and a Respiratory Discrimination Task.Three measures of interoception were extracted: Interoceptive accuracy (IAcc), Interoceptive awareness (IAwe), and Interoceptive sensibility (ISen).Results from this experiment indicated that IAcc and IAwe were not correlated across domains.Of note, a significant difference was found between the two estimates of IAcc, indicating that participants were more accurate at assessing interoception in the respiratory than in the cardiac domain.Furthermore, younger adults (M= 0.49, SD = 0.29) exhibited significantly higher IAcc than older adults (M= 0.67, SD = 0.23); (t(36) = -2.04,p < 0.02) in the cardiac domain.These results indicate dissociable outcomes for two methods of assessing interoception, as well as illustrate the potentially prominent role age may hold when examining variability in interoceptive ability across domains.

METABOLIC SYNDROME, LIFESTYLE FACTORS, AND SLEEP-DISORDERED BREATHING IN US HISPANICS: IMPLICATIONS FOR MID LIFE
Shannon Richard, Du Feng, Dieu-My Tran, Brenna Renn, and Jinyoung Kim, University of Nevada, Las Vegas, Las Vegas, Nevada, United States US Hispanics/Latinos are disproportionately susceptible to metabolic syndrome (MetS), attributed in part to health and lifestyle factors such as low physical activity levels, diet quality, alcohol use, tobacco use, and sleep-disordered breathing.The risk of MetS and MetS-related complications increases with age.We examined the relationships between select health and lifestyle factors and MetS among Hispanic gender-heritage subgroups and determined whether gender and heritage moderate those relationships.Participants included 14,155 Hispanic Americans aged 18-76 (59% women, mean age 45.92 ± 13.97) from seven heritage subgroups.This secondary analysis of cross-sectional data from the observational Hispanic Community Health Study / Study of Latinos dataset used multinomial logistic regression and Hayes' PROCESS macro to test these relationships; the dependent variable, MetS, included four categories delineating MetS and related medication use.Results include low physical activity (p< .001)and sleep-disordered breathing (p< .001)were associated with the MetS with medication use group.High alcohol use decreased the probability of being in this group (p< .001).Cigarette pack years were not significantly associated with MetS outcomes.Gender moderated the association between MetS and diet quality (p< .001),alcohol use (p< .001),cigarette pack-years (p< .001),and sleepdisordered breathing (p< .001).Low physical activity and sleep-disordered breathing was significantly associated with MetS group membership, whereas low and high alcohol use were associated with decreased MetS risk.Gender-heritage differences were prominent in each of the study variables.Midlife may be an important target for prevention and intervention; other considerations for aging will be discussed.

MYOGENIC CONTRIBUTORS TO PHYSICAL FUNCTION IN OLDER ADULTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS
Alisa Johnson 1 , Jennifer Nichols 1 , Heather Vincent 1 , Roger Fillingim 2 , and Yenisel Cruz-Almeida 2 , 1. University of Florida, Gainesville, Florida, United States, 2. The University of Florida, Gainesville, Florida, United States Knee osteoarthritis (OA) is a leading cause of mobility disability among middle-aged and older adults, and contributes to significant global disease burden.The impact of knee OA on physical function varies widely across individuals, and the factors contributing to this heterogeneity are poorly understood.Recent compelling research suggests that myogenic factors, including muscle quality (MQ), may underly symptoms in knee OA.While MQ is gaining attention in aging research, the role of MQ on functional outcomes in persons with knee OA remains unknown.This pilot study examined morphological and neuromuscular biomarkers of MQ among adults aged 50 years and older (N=44) who met clinical criteria for symptomatic knee OA.Physical performance was assessed using the Short Physical Performance Battery (SPPB).MQ was quantified using B-mode ultrasound (echo intensity) and isokinetic strength measures (force/body mass).Associations between MQ and physical performance were determined, with consideration for clinical pain, age, sex, and body mass index.Pearson correlation analysis indicated SPPB scores were associated with clinical pain, strength, and MQ (r values ranged -.42 -0.60, p's< 0.05).Multivariable backward stepwise linear regression analysis demonstrated that MQ biomarkers contributed 39% to variance for SPPB score independent of clinical pain and strength,